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Dhakal AK, Shrestha D, Kc D, Yadav SP. A narrative review of acute post-streptococcal glomerulonephritis in Nepali children. BMC Nephrol 2025; 26:142. [PMID: 40119285 PMCID: PMC11929318 DOI: 10.1186/s12882-025-04073-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Accepted: 03/14/2025] [Indexed: 03/24/2025] Open
Abstract
BACKGROUND Acute post-streptococcal glomerulonephritis (APSGN) is the primary cause of acute glomerulonephritis in children in Nepal and contributes significantly to paediatric hospitalisations in the country. This review discusses the current status of streptococcal infections, epidemiological trends, and the challenges in diagnosing and managing APSGN in Nepalese children. This study aimed to develop local data on acute post-streptococcal glomerulonephritis to help compare epidemiological trends and patterns with regions where this disease is less prevalent. METHODS A targeted literature review was conducted in PubMed, Google Scholar, and Nepal Journals Online (a local database) to identify relevant literature published between 1 January 2000 and 31 December 2024. Additional searches of conference abstracts and reviews were performed using Google. The collected literature was analysed to determine the kidney disease patterns, current status of Group A Streptococcal infection, epidemiological trends, clinical manifestations, management, and outcomes of APSGN in Nepali children aged < 16 years. RESULTS Thirty-four articles were selected for in-depth review. A synthesis of local hospital studies revealed significant differences in the application of diagnostic criteria for APSGN owing to the inaccessibility of serological tests and complement testing. Children over five years of age, particularly those aged 8 to 11 years and predominantly male, were more severely affected. The disease was present year-round, with pyoderma identified as the main route of preceding streptococcal infection rather than throat infection, particularly affecting economically disadvantaged children. The classical manifestations were oedema, hypertension, gross haematuria, and oliguria, whereas complications included acute kidney injury, rapidly progressive glomerulonephritis, hypertensive emergency, congestive cardiac failure, and the need for kidney replacement therapy. The anti-streptolysin O titre was positive in 34-72.7% of patients, while complement C3 levels were depressed in 61.9-100% of cases. Urinalysis showed haematuria in 67-100% of patients and pyuria in 7.9-37%. Kidney ultrasonography indicated increased echogenicity in 37-78% of the cases. Most patients were managed conservatively with diuretics and anti-hypertensives. Atypical cases and those with a progressive disease course were further managed with steroids, kidney biopsies, or kidney replacement therapy. Most patients exhibited favourable short-term kidney outcomes. There was low mortality among patients with rapidly progressive glomerulonephritis and those who required kidney replacement therapy. CONCLUSIONS This review highlights that acute post-streptococcal glomerulonephritis remains a common cause of hospitalisation in Nepal. It remains a diagnostic difficulty owing to the inaccessibility of serological and complement tests. The disease has distinct clinical manifestations, demographic patterns, histological findings and outcomes in Nepali children.
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Affiliation(s)
- Ajaya Kumar Dhakal
- Department of Paediatrics, KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal.
| | - Devendra Shrestha
- Department of Paediatrics, KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal
| | - Divya Kc
- Department of Paediatrics, KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal
| | - Shankar Prasad Yadav
- Department of Paediatrics and Adolescent Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
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Ranawaka R, Dayasiri K, Sandakelum U, Nelson D, Gamage M. Post-streptococcal acute glomerulonephritis in children: Association between proteinuria levels and renal outcomes. World J Clin Pediatr 2025; 14:100885. [DOI: 10.5409/wjcp.v14.i1.100885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 10/22/2024] [Accepted: 11/25/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Post-streptococcal acute glomerular nephritis (PSAGN) is mostly a benign condition. The usual sequelae of PSAGN include hypertension, its complications, and acute kidney injury. Severe PSAGN is associated with significant long-term morbidity, and histological abnormalities such as crescentic glomerulonephritis are infrequently reported. PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.
AIM To evaluate the association between proteinuria levels and renal outcomes in children with PSAGN.
METHODS This prospective observational study was conducted at Lady Ridgeway Hospital (Colombo, Sri Lanka) over 15 months. Children with PSAGN were enrolled based on clinical and laboratory criteria. Persistent proteinuria ≥ 2+ for 2 weeks and serum creatinine > 100 μmol/L warranted renal biopsy, assessed via light microscopy and immunofluorescence. Normalization of complement 3 (C3) within 6 to 8 weeks was required for inclusion. Data on clinical features, urine protein levels, and renal function were collected from patient records, and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing. Ethical approval was obtained from the Ethical Review Committee, Lady Ridgeway Hospital for Children (Ref No: LRH/ERC/2021/60).
RESULTS Forty-four patients were recruited. There were 27 (61.4%) male patients and 17 (38.6%) female patients. Thirty-seven (84%) of them were above 5 years of age. Twenty (45%) patients had a history of skin sepsis, and eighteen (41%) had a history of throat infection. Among patients with proteinuria ≥ 2+, 53% had serum creatinine > 100 µmol/L, while among those with proteinuria < 2+, 7% had serum creatinine > 100 µmol/L. The association of high-degree proteinuria with elevated serum creatinine was significant (χ² = 7.8, P = 0.005) in PSAGN. The odds ratio of the logistic regression model was 1.049 (95% confidence interval: 1.003-1.098), indicating a positive direction with statistically significant association (P = 0.037). There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance. Ten children underwent renal biopsy. Crescents (less than 50%) were demonstrated in five children, while three children had typical diffuse proliferative glomerulonephritis. One child had severe acute tubular necrosis, and another had crescentic glomerulonephritis (crescents > 50%). The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.
CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine (> 100 μmol/L) in children with PSAGN. The majority of children with persistent proteinuria ≥ 2+ for more than 2 weeks and the highest recorded serum creatinine > 100 μmol/L had atypical renal histological findings.
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Affiliation(s)
- Randula Ranawaka
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 0094, Sri Lanka
- University Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo 0094, Western, Sri Lanka
| | - Kavinda Dayasiri
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama 0094, Sri Lanka
| | - Udara Sandakelum
- University Pediatric Unit, Lady Ridgeway Hospital for Children, Colombo 0094, Western, Sri Lanka
| | - Dulani Nelson
- University Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo 0094, Western, Sri Lanka
| | - Manoji Gamage
- Nutrition Division, Ministry of Health, Colombo 0094, Sri Lanka
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Dotis J, Kondou A, Karava V, Siolos P, Georgopoulou V, Liapis G, Stamou M, Papachristou F, Printza N. Percutaneous Ultrasound-Guided Renal Biopsy in Greek Children: 15 Years of Experience at a Single Center. Pediatr Rep 2024; 16:974-982. [PMID: 39585037 PMCID: PMC11587433 DOI: 10.3390/pediatric16040083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 11/02/2024] [Accepted: 11/05/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND Percutaneous ultrasound-guided renal biopsy (PRB) is a key element for diagnosis and management of several renal pathologies. We aimed to lay out the experience of our pediatric nephrology unit performing PRBs. The rationale and findings of these biopsies, safety issues and considerations of the extracted data are going to be analyzed. METHODS A retrospective study was conducted from 2008 to 2023 based on the review of the medical records of pediatric patients who underwent PRBs. In total, 216 kidney biopsies in 206 patients were performed: 115 (53.2%) during the 2008-2015 period and 101 (46.8%) during the 2016-2023 period. RESULTS The most frequent clinical indication for PRBs was nephritic syndrome followed by nephrotic syndrome, observed in 84 (40.8%) and 72 (34.9%) patients, respectively. The predominant diagnosis was minimal change disease (MCD) (23.3%), followed by focal segmental glomerulosclerosis (FSGS) (15%) equal to lupus nephritis (LN) (15%), and immunoglobulin A nepropathy (10.2%). Minor complications, such as subcapsular hematomas were observed in approximately 15% of patients while no therapeutic intervention was needed. CONCLUSIONS This report is the first review of pathohistological data covering a pediatric population over a 15-year period in Greece and one of the largest in southeastern Europe, especially in the Balkan region. The main indication for a PRB was nephritic syndrome; however, MCD was the main histological diagnosis. This study emphasis the fact that PRBs constitute a safe and reliable method of diagnostic approach to kidney diseases in childhood and offers important information on therapeutic approaches as well as the prognosis of these patients.
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Affiliation(s)
- John Dotis
- Pediatric Nephrology Unit, First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece; (A.K.); (V.K.); (P.S.); (N.P.)
| | - Antonia Kondou
- Pediatric Nephrology Unit, First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece; (A.K.); (V.K.); (P.S.); (N.P.)
| | - Vasiliki Karava
- Pediatric Nephrology Unit, First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece; (A.K.); (V.K.); (P.S.); (N.P.)
| | - Pavlos Siolos
- Pediatric Nephrology Unit, First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece; (A.K.); (V.K.); (P.S.); (N.P.)
| | - Vivian Georgopoulou
- Radiology Department, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece;
| | - George Liapis
- First Pathological Anatomy Department, Laikon General Hospital of Athens, 11567 Athens, Greece;
| | - Maria Stamou
- Second Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Fotios Papachristou
- Pediatric Nephrology Unit, First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece; (A.K.); (V.K.); (P.S.); (N.P.)
| | - Nikoleta Printza
- Pediatric Nephrology Unit, First Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece; (A.K.); (V.K.); (P.S.); (N.P.)
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LEVENTOGLU E, SORAN M. Clinical Characteristics of Children with Acute Post-Streptococcal Glomerulonephritis and Re-Evaluation of Patients with Artificial Intelligence. Medeni Med J 2024; 39:221-229. [PMID: 39350577 PMCID: PMC11572215 DOI: 10.4274/mmj.galenos.2024.09382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 08/29/2024] [Indexed: 11/20/2024] Open
Abstract
Objective Acute post-streptococcal glomerulonephritis (APSGN) is a common cause of acute glomerulonephritis in children. The condition may present as acute nephritic and/or nephrotic syndrome and rarely as rapidly progressive glomerulonephritis. ChatGPT (OpenAI, San Francisco, California, United States of America) has been developed as a chat robot supported by artificial intelligence (AI). In this study, we evaluated whether AI can be used in the follow-up of patients with APSGN. Methods The clinical characteristics of patients with APSGN were noted from patient records. Twelve questions about APSGN were directed to ChatGPT 3.5. The accuracy of the answers was evaluated by the researchers. Then, the clinical features of the patients were transferred to ChatGPT 3.5 and the follow-up management of the patients was examined. Results The study included 11 patients with an average age of 9.08±3.96 years. Eight (72.7%) patients had elevated creatinine and 10 (90.9%) had hematuria and/or proteinuria. Anti-streptolysin O was high in all patients (955±353 IU/mL) and C3 was low in 9 (81.8%) patients (0.56±0.34 g/L). Hypertensive encephalopathy, nephrotic syndrome, and rapidly progressive glomerulonephritis were observed in three patients. Normal creatinine levels were achieved in all patients. Questions assessing the definition, epidemiologic characteristics, pathophysiologic mechanisms, diagnosis, and treatment of APSGN were answered correctly by ChatGPT 3.5. All patients were diagnosed with APSGN, and the treatment steps applied by clinicians were similarly recommended by ChatGPT 3.5. Conclusions The insights and recommendations offered by ChatGPT for patients with APSGN can be an asset in the care and management of patients. With AI applications, clinicians can review treatment decisions and create more effective treatment plans.
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Affiliation(s)
- Emre LEVENTOGLU
- Konya City Hospital, Clinic of Pediatric Nephrology, Konya, Türkiye
| | - Mustafa SORAN
- Konya City Hospital, Clinic of Pediatric Nephrology, Konya, Türkiye
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Wong W, Prestidge C, Zwi J, Han DY. Biomarkers of histologic severity in children with severe or atypical acute post-streptococcal glomerulonephritis. Pediatr Nephrol 2024; 39:1801-1808. [PMID: 38117311 DOI: 10.1007/s00467-023-06249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/27/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Acute post-streptococcal glomerulonephritis (APSGN) is a common cause of acute kidney injury (AKI) in children; however, in a small subgroup, the presentation is one of rapidly progressive glomerulonephritis (RPGN) deteriorating kidney function associated with severe oligo-anuria or a mixed nephritic-nephrotic picture. This study reviewed potential clinical and laboratory factors which may assist the treating clinician to identify patients at high risk of severe disease. METHODS All kidney biopsies for APSGN performed between 1996 and 2020 were obtained from a departmental biopsy database. Clinical and laboratory data were extracted from the patients' clinical records. Kidney biopsies were reviewed and scored independently by a renal histopathologist. RESULTS Thirty of 53 (56.6%) patients had stage 3 AKI at initial presentation with a median estimated glomerular filtration rate (eGFR) 27 (IQR 11-41), falling to 20 ml/min/1.73 m2 (IQR 13.3-43) at time of biopsy. Patients who had either a pre-biopsy eGFR < 35 ml/min/1.73 m2 or a ≥ 25% fall in eGFR between admission and biopsy were more likely to have glomerular crescents (p = 0.004). Multivariate regression analysis and receiver operating curve showed the pre-biopsy eGFR most accurately predicted glomerular crescents (p = 0.047, ROC 0.757). There were no significant predictors of nephrotic proteinuria or nephrotic syndrome during the acute phase. CONCLUSIONS Severe APSGN is associated with a pronounced reduction in eGFR. Calculation of eGFR in this small group of patients may assist in identifying which patient should have an urgent kidney biopsy to facilitate a more accurate clinical diagnosis and management plan.
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Affiliation(s)
- William Wong
- Department of Paediatric Nephrology, Starship Children's Hospital, 3 Park Road, Grafton, Auckland, New Zealand.
| | - Chanel Prestidge
- Department of Paediatric Nephrology, Starship Children's Hospital, 3 Park Road, Grafton, Auckland, New Zealand
| | - Jonathan Zwi
- Department of Anatomic Pathology, LabPlus, Auckland City Hospital, 3 Park Road, Grafton, Auckland, New Zealand
| | - Dug Yeo Han
- Starship Research and Innovation, Starship Children's Hospital, 160 Grafton Road, Grafton, Auckland, New Zealand
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Mosquera-Sulbaran JA, Pedreañez A, Carrero Y, Hernandez-Fonseca JP. Angiotensin II and post-streptococcal glomerulonephritis. Clin Exp Nephrol 2024; 28:359-374. [PMID: 38170299 DOI: 10.1007/s10157-023-02446-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Post-streptococcal glomerulonephritis (PSGN) is a consequence of the infection by group A beta-hemolytic streptococcus. During this infection, various immunological processes generated by streptococcal antigens are triggered, such as the induction of antibodies and immune complexes. This activation of the immune system involves both innate and acquired immunity. The immunological events that occur at the renal level lead to kidney damage with chronic renal failure as well as resolution of the pathological process (in most cases). Angiotensin II (Ang II) is a molecule with vasopressor and pro-inflammatory capacities, being an important factor in various inflammatory processes. During PSGN some events are defined that make Ang II conceivable as a molecule involved in the inflammatory processes during the disease. CONCLUSION This review is focused on defining which reported events would be related to the presence of this hormone in PSGN.
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Affiliation(s)
- Jesus A Mosquera-Sulbaran
- Facultad de Medicina, Instituto de Investigaciones Clínicas "Dr. Américo Negrette", Universidad del Zulia, Apartado Postal: 23, MaracaiboZulia, 4001-A, Venezuela.
| | - Adriana Pedreañez
- Facultad de Medicina, Cátedra de Inmunología, Escuela de Bioanálisis, Universidad del Zulia, Maracaibo, Venezuela
| | - Yenddy Carrero
- Facultad de Medicina, Instituto de Investigaciones Clínicas "Dr. Américo Negrette", Universidad del Zulia, Apartado Postal: 23, MaracaiboZulia, 4001-A, Venezuela
| | - Juan Pablo Hernandez-Fonseca
- Facultad de Medicina, Instituto de Investigaciones Clínicas "Dr. Américo Negrette", Universidad del Zulia, Apartado Postal: 23, MaracaiboZulia, 4001-A, Venezuela
- Servicio de Microscopia Electrónica del Centro Nacional de Biotecnología, CNB-CSIC, Madrid, Spain
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Bajracharya P, Khadgi A, Shrestha S, Silwal R, Tandukar A. Acute Post-streptococcal Glomerulonephritis in a Pediatric Population: A Five-Year Retrospective Study. Cureus 2024; 16:e56082. [PMID: 38618409 PMCID: PMC11009898 DOI: 10.7759/cureus.56082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION Post-streptococcal glomerulonephritis is a kidney disease that occurs after infection with a certain strain of streptococcal bacteria. It has a high hospitalization rate, especially in developing countries. It is characterized by the sudden appearance of edema, hematuria, proteinuria, and hypertension. The objective of this retrospective descriptive study conducted at James L. Gordon Memorial Hospital in Olongapo, Zambales, Philippines, is to analyze the demographic distribution, clinical presentation, complication, and outcome of acute post-streptococcal glomerulonephritis (APSGN) in a pediatric population. Methods: A retrospective descriptive study was done in patients (below 18 years of age) admitted with the diagnosis of post-streptococcal glomerulonephritis during a five-year period in the pediatric ward of a tertiary hospital in the Philippines. All patients underwent detailed clinical history and examination and were closely monitored during treatment. The course of disease progression was closely monitored and recorded. RESULTS Seventy-seven children were treated for APSGN with a mean age of 7.8 years and with standard deviation of 3.85. Edema and gross hematuria were noted in 53 (68.8%) and 24 (31.1%) cases, respectively. Hypertension was present in 54 patients (70.1%). Among those 54 patients, 49 (63.6%) patients developed acute renal injury (based on normal creatinine for age), three cases (3.8%) had pleural effusion, and two patients (2.5%) developed hypertensive encephalopathy. All patients underwent KUB (kidneys, ureters, and bladder) ultrasound, among which 13 (16.88%) had diffuse parenchymal swelling which improved and eventually were discharged. Increased blood urea nitrogen (BUN) was noted in 60-65% of patients. Hypoalbuminemia and lower hemoglobin were also quite common. There was no mortality during treatment and hospital stay. CONCLUSIONS APSGN remains one of the most common causes of glomerulonephritis in the region. Edema, hypertension, and hematuria were the most common presenting features. Early identification and comprehensive monitoring and management are required to prevent morbidity and mortality. The prognosis is generally good if early treatment is done.
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Affiliation(s)
| | - Ashish Khadgi
- Department of Ear, Nose, and Throat and Head and Neck Surgery, Lamahi Eye Hospital, Lamahi, NPL
| | - Sugandha Shrestha
- Department of Obstetrics and Gynaecology, Buddha International Hospital, Ghorahi, NPL
| | - Ramji Silwal
- Department of Pediatrics, Alka Hospital, Kathmandu, NPL
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Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Group A β-hemolytic Streptococcal Pharyngitis: An Updated Review. Curr Pediatr Rev 2024; 21:2-17. [PMID: 37493159 DOI: 10.2174/1573396320666230726145436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Group A ß-hemolytic Streptococcus (GABHS) is the leading bacterial cause of acute pharyngitis in children and adolescents worldwide. OBJECTIVE This article aims to familiarize clinicians with the clinical manifestations, evaluation, diagnosis, and management of GABHS pharyngitis. METHODS A search was conducted in December 2022 in PubMed Clinical Queries using the key term "group A β-hemolytic streptococcal pharyngitis". This review covers mainly literature published in the previous ten years. RESULTS Children with GABHS pharyngitis typically present with an abrupt onset of fever, intense pain in the throat, pain on swallowing, an inflamed pharynx, enlarged and erythematous tonsils, a red and swollen uvula, enlarged tender anterior cervical lymph nodes. As clinical manifestations may not be specific, even experienced clinicians may have difficulties diagnosing GABHS pharyngitis solely based on epidemiologic or clinical grounds alone. Patients suspected of having GABHS pharyngitis should be confirmed by microbiologic testing (e.g., culture, rapid antigen detection test, molecular point-of-care test) of a throat swab specimen prior to the initiation of antimicrobial therapy. Microbiologic testing is generally unnecessary in patients with pharyngitis whose clinical and epidemiologic findings do not suggest GABHS. Clinical score systems such as the Centor score and McIssac score have been developed to help clinicians decide which patients should undergo diagnostic testing and reduce the unnecessary use of antimicrobials. Antimicrobial therapy should be initiated without delay once the diagnosis is confirmed. Oral penicillin V and amoxicillin remain the drugs of choice. For patients who have a non-anaphylactic allergy to penicillin, oral cephalosporin is an acceptable alternative. For patients with a history of immediate, anaphylactic-type hypersensitivity to penicillin, oral clindamycin, clarithromycin, and azithromycin are acceptable alternatives. CONCLUSION Early diagnosis and antimicrobial treatment are recommended to prevent suppurative complications (e.g., cervical lymphadenitis, peritonsillar abscess) and non-suppurative complications (particularly rheumatic fever) as well as to reduce the severity of symptoms, to shorten the duration of the illness and to reduce disease transmission.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benjamin Barankin
- Department of Dermatology, Toronto Dermatology Centre, Toronto, Ontario, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
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Matsell DG, Cojocaru D, Catapang M. Risk factors associated with short- and long-term kidney injury in children with post infectious glomerulonephritis. Pediatr Nephrol 2023; 38:3309-3315. [PMID: 37145185 DOI: 10.1007/s00467-023-06000-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Post infectious glomerulonephritis (PIGN) is the most common form of acute glomerulonephritis in children. The objective of this study was to evaluate the risk factors for kidney injury in children with PIGN referred to a tertiary care center. METHODS This was a retrospective cohort study. The primary outcome was acute kidney injury (AKI) at initial presentation; secondary outcome was composite kidney injury, defined as reduced estimated glomerular filtration rate (eGFR), proteinuria, or hypertension at last follow-up. Binary logistic regression defined risk factors associated with the primary and secondary outcomes. RESULTS We identified 125 PIGN cases with a mean age of 8.3±3.5 years at presentation and 252 ± 501 days of follow-up. Sixty-six percent (79/119) presented with AKI and 57% (71/125) were admitted to hospital. Shorter time to seeing a nephrologist (OR 6.7, 95%CI 1.8-24.6), nadir C3 < 0.12 g/L (OR 10.2, 95%CI 1.9-53.7), starting an antihypertensive medication (OR 7.6, 95%CI 1.8-31.3), and nephrotic range proteinuria (OR 3.8, 95%CI 1.2-12.4) were independent risk factors for AKI when adjusted for each other. At last follow-up 35% (44/125) of the cohort had the composite outcome, with older age at presentation (OR 1.2, 95%CI 1.04-1.4) and nadir C3 < 0.17 g/L (OR 2.6, 95%CI 1.04-6.7) being independent risk factors when adjusted for AKI. CONCLUSION PIGN is an important cause of AKI in children and adolescents. The severity of initial illness is associated with the extent of kidney injury in both the short- and longer-term. Findings will help identify cases requiring lengthier surveillance. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Douglas G Matsell
- Department of Pediatrics, Division of Nephrology, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, BC, K4-156, Canada.
| | - Dan Cojocaru
- Department of Pediatrics, Division of Nephrology, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, BC, K4-156, Canada
| | - Marisa Catapang
- Department of Pediatrics, Division of Nephrology, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, Vancouver, BC, K4-156, Canada
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Iyengar A, Kamath N, Radhakrishnan J, Estebanez BT. Infection-Related Glomerulonephritis in Children and Adults. Semin Nephrol 2023; 43:151469. [PMID: 38242806 DOI: 10.1016/j.semnephrol.2023.151469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Infection-related glomerulonephritis is an immunologically mediated glomerular injury after an infection. Glomerulonephritis may occur with the infection or after a variable latent period. Poststreptococcal glomerulonephritis (PSGN) is the prototype of infection-related glomerulonephritis. The streptococcal antigens, nephritis-associated plasmin-like receptor and streptococcal exotoxin B, have emerged as major players in the pathogenesis of PSGN. Although PSGN is the most common infection-related glomerulonephritis in children, in adults, glomerulonephritis is secondary to bacteria such as staphylococci, viruses such as hepatitis C, and human immunodeficiency virus, and, rarely, parasitic infections. Supportive therapy is the mainstay of treatment in most infection-related glomerulonephritis. Treatment of the underlying infection with specific antibiotics and antiviral medications is indicated in some infections. Parasitic infections, although rare, may be associated with significant morbidity. Poststreptococcal glomerulonephritis is a self-limiting condition with a good prognosis. However, bacterial, viral, and parasitic infections may be associated with significant morbidity and long-term consequences. Epidemiologic studies are required to assess the global burden of infection-related glomerulonephritis. A better understanding of the pathogenesis of infection-related glomerulonephritis may unravel more treatment options and preventive strategies.
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Affiliation(s)
- Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bengaluru, India.
| | - Nivedita Kamath
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bengaluru, India
| | - Jai Radhakrishnan
- Department of Nephrology, Columbia University Medical Center, New York, NY
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Kuang Q, He X, Jia L, Zhang Z, Gui C, Gao C, Xia Z. Case report: A pediatric case of MPO-ANCA-associated granulomatosis with polyangiitis superimposed on post-streptococcal acute glomerulonephritis. Front Pediatr 2023; 11:1148132. [PMID: 37492611 PMCID: PMC10364118 DOI: 10.3389/fped.2023.1148132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
An eight-year-old girl was admitted with vomiting, gross hematuria, and progressive renal dysfunction. A renal biopsy revealed endocapillary proliferative glomerulopathy and crescent formation. Immunofluorescence staining revealed diffuse granular deposits of IgG and C3. Post-streptococcal acute glomerulonephritis (PSAGN) was suspected, based on the elevated anti-streptolysin O levels, decreased serum C3 concentrations, and histologic findings. The myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) test was positive, and the young patient gradually developed palisaded neutrophilic and granulomatous dermatitis (PNGD), orbital and paranasal sinus granulomatous neoplasms, along with intermittent nose, head, and orbital pain. Finally, she was diagnosed with the rare MPO-ANCA-associated granulomatosis with polyangiitis (GPA) superimposed on PSAGN. The patient was treated with aggressive renal replacement therapy, methylprednisolone pulse therapy, and intravenous pulse cyclophosphamide; her renal function normalized, and her pain symptoms improved.
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